HomeMy WebLinkAboutSKY RIDGE LT 21t � I DOM www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: OSP 231309 Date of Issue 9/18/23 Parcel Identification Number: 01527521000 Legal Description Property Owner Name & Address Sky Ridge LT 21 Hultquist Homes 10851 Sky Ridge Dr. Anchorage, AK 99516 Pump Installation Date: 2/27/24 Pump Intake Depth Below Top of Well Casing: 151 feet Pump manufacturer’s Name: Grundfos Pump Model: 10SQE07-240 Pump Size: 3/4 hp Pitless Adapter Burial Depth: 11 feet Pitless Adapter Installer: Pitless Manufacturer: Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Merrill Hultquist Homes Certified Drilling Log OWNER OF LAND: Hultquist Homes ADDRESS: 10851 Sky Ridge Dr. Anchorage, AK 99516 LEGAL DESCRIPTION SKY RIDGE LT 21 DATE: 1/30/24 PERMIT NUMBER: OSP231309 DATE OF ISSUE: 9/17/23 TAX IDENTIFICATION NUMBER 01527521000 Is well located at approved permit location: Yes No Method of Drilling: air rotary cable tool Depth of Well: 164’ Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 160 feet Liner type Static Water Level: 65.5 feet Recovery Rate 12 gpm gph Method of Testing Air Well Intake Opening Type: open end open hole Screened Start feet Stopped Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs. Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: yes no Method of Disinfection: Chlorine 50 PPM Comments: Bore Hole Data Depth From To 0 2 Casing Stickup 2 4 Gravel, silt and sand 4 15 Gravel and sand 15 18 Gravel 18 34 Gravel silt with clay 34 38 Gravel 38 40 Gravel silt 40 58 Silt some gravel 58 78 Black silt and gravel 78 95 Gravel 95 98 Gravel with silt 98 120 Gravel some water 120 138 Gravel silt 138 164 Gravel water Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water System Permit Permit Number: OSP231309 Work Type: Well Initial Tax Code Number: 01527521000 Site Legal Address: SKY RIDGE LT 21 G:2634 Site Mailing Address: 10851 SKY RIDGE DR, Anchorage Owner: HULTQUIST HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: nr s, Department 9/18/2023 9/17/2024 Lot Size in Sq Ft: 20009 Total Bedrooms: 5 Q Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: � 5 v1' ( _D 1 ` F,S Date: Issued By: Date: J i/ -2L -2-- MUNICIPALITY F ANCHORAGE s Community Development Department �` - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program el R � i ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-275-21 Property owner(s) Hultguist Homes, Inc. Day phone Mailing address 12570 Old Seward Highway Anchorage, AK 99515 Site address 10851 Sky Ridge Drive Legal description (Sub'd., Block & Lot) Sky Ridge Lot 21 Legal description (Township, Range & Section) Lot Size 20,009 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial X❑ Single Family (SF) ADU) Septic Tank ElUpgrade 1-1(w/wo Duplex (D) Holding Tank ElRenewal ElMultiple Dwellings Privy ❑ (SF and/or D) Private Well X❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Em (Signature of property owner or authorized agent) Permit/Rush Fees: S t lam. Waiver Fees: Date of Payment: 519 /'ZO ZS Date of Payment: Receipt Number: 0 Rs W T G Receipt Number: Permit No. 0 S P Z s i 3 0 i Waiver No. Permit App_'- : :'-.,'c X❑ Municipality of Anchorage On-site Water and Wastewater • • REVIEWED FOR CODE COMPLIANT Pannone Engineering e r ices LLC OSP231309, Curtis Townsend, 091V Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 6 September 2023 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Sky Ridge Lot 21 Well Permit Request Well Design Narrative This is a design narrative for a permit to install a private well to be issued for this property. Currently the lot has an existing well that will be decommissioned per MOA code. This lot and the surrounding lots are to be served by public sewer. Currently there are no sewer mains or private septic systems within 100' of the proposed installation. 1. Initial Well Design. The well will be located: 100'+ from any sewer main. 100'+ from any on-site septic system. 25'+ from any private sewer lines. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, Is T;�__p Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Existing well located where house is showing on the plot plan. The existing to be decommissioned per MOA code. NO WELLS/SEPTICS WITHIN 200' OMALLEY ROAD NO WELLS/SEPTICS WITHIN 200' �_ 10' T&E EASEMENT I M SS 3S � ASSUMED SEPTIC �` Li rl� SERVICE LOCATION / w 4 V) W c� \ BR a Cn HOUSE LOT Q I/ (P) o \ / 21 -'8 NO WELLS/SEPTICS �` WITHIN I Cn Cn ch I m cn I cn I a CD I 01, LU it w 0 0 Of Y V) 200 CD I I N �R/lrE�gY WELL (P) � I � \ NO WELLS/SEPTICS / WITHIN 200' w� W�' w� I LOT 22 I For construction PAMONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DRAWN BY: DRM SKY RIDGE, LOT 21 HULTQUIST HOMES 10851 SKY RIDGE DRIVE PLAN ANCHORAGE, AK Date 9/6/2023 Scale I"=50' P.I.D. NO 015-275-21 PERMIT NO. OSPXXXXXX Sheet 1 OF 2 SPECIAL PROVISIONS TO SPECIFICATIONS On-site Water and V) 1. SCOPE AND SPECIFICATIONS: REVIEWED FOR CODE tt 1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MOA COMPONENT PARTS AND MA�ERIALIMED IN To CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 1.2. CONTRACTED WORK WILL BE IN COMPLIANCE WITH MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) DIVISION 10 & DIVISION 20 AS APPROPRIATE. 1.3. SCOPE OF WORK: INSTALL WELL. 1.4. 1.5. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER; A PLOT PLAN DEVELOPED BY RLS; OR A SURVEY AS—BUILT. 2. CONSTRUCTION SPECIFICATIONS: 2.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN 2.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. 2.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL ROCK SURFACE TO f1" PRIOR TO INSTALLING THE PERFORATED PIPE. 2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. 2.5. ALL INSULATION SHALL BE 2" THICK DOW HI -40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES. 2.6. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. 2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. 2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. 2.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS PER MOA CODE. 2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM. 2.11. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. 2.12. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON IAW WITH MOA CODE IF NEEDED. 3. CONTRACTOR RESPONSIBILITIES: 3.1. THE CONTRACTOR SHALL FAMILIARIZE THEMSELVES WITH THE SITE CONDITIONS AND LOCATIONS OF ALL LOT LINES, EASEMENTS, WELLS (E & P), SEPTIC SYSTEMS (E & P) AND SHALL MEET MINIMUM SEPARATION DISTANCES OR AS NOTED. 3.2. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 3.3. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 3.4. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 3.5. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 3.6. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 3.7. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 3.8. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 4. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WILL BE PERFORMED IN ACCORDANCE WITH THE APPROVED PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: DATE: construction PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SKY RIDGE, LOT 21 HULTQUIST HOMES 10851 SKY RIDGE DRIVE DESIGN DETAILS ANCHORAGE, AK Date 9/6/2023 Scale NTS P.I.D. NO 015-275-21 PERMIT NO Sheet 2OF2 0911E • MUNICIPALITY OF ANCHORAGE ar Development Services Department phone: 907-343-7904 On -Site Water & Wastewater Section \ -`� Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-275-21 Legal description SKY RIDGE LT 21 Site address 10851 SKY RIDGE DR Anchorage AK Current property owner(s) HULTQUIST HOMES Expiration Date: 19 The On -site system(s) is/are approved for 5 bedrooms 2/27/2025 Conditional approval for bedrooms, with the following stipulations: Comments or advisories: -M Original Certificate Date: 7/25/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department A'AlY, Phone- 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343-7997 - I i^ Certificate of On -Site Systems Approval Application R 1. GENERAL INFORMATION Parcel I.D. 01527521 Complete legal description Sky Ridge L21 Location (site address) 10851 Sky Ridge Current property owner(s) Hultquist Homes, Inc. 2. ON -SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: FN Private Well r-1 Private Well serving 2 dwelling units E] Private Well serving 3+ dwelling units R Community Well or Public M Water Storage 4. TYPE OF WASTEWATER DISPOSAL: R Private Septic R Private Septic serving 2 dwelling units El Holding Tank X Community Septic or Public Sewer 5. SEPTIC TANK: Fj Steel F-I Plastic R Concrete R Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: R AWWTS 0 Bed R Deep Trench 0 Wide Trench R Seepage Pit Waiver request for: Expedited review requested: F* Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment 7 Z L �,- Date of Payment COSA # C) _S C -z- y I Z Waiver # COSA Application June 2022 Legal Description: Sky Ridge L21 COSA Checklist 01527521 Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA M Well log is filed with Onsite (or attached) Date drilled 1110124 Total depth 164 ft Cased to 160 ft Sanitary seal is functioning correctly ❑x Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 1/30/24 Static water level at beginning of test 65.5 ft Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments:. D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Well production at time of test 12 gpm Water storage tank volume none gallons Well disinfected for coliform test? © Yes ❑ No El Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Sullivan's Date 2/27/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results U Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used I in Effective depth remaining in r"i COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' n Yes if No ft n Yes if No ft Neighboring Tank > 100' © Yes if No ft Private Sewer/Septic Line > 25' x❑ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' x❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ❑x Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑x Yes if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS Well supposedly located directly under where the house foundation was excavated. Excavation to 10' below grade occurred with no sign of any well present. MoA Building Department inspector (Heath) noted nothing unusual during foundation hole inspection. It appears the old plat prior to the Sky Ridge Plat likely incorrectly indicated an existing well on the lot. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services Engineer's Printed Name Steven R Pannone P.E., F. ASCE Phone 907-745-8200 COSA Checklist —June 2022 Date 7/22/24 Lot 21 Sky Ridge Subdivision As-Built Land Surveying Land Development Consultants Subdivision Specialists Construction Surveying AEC# 173042 S4 Group 124 E 7th Avenue Anchorage, Alaska 99501 (907) 306-8104 mail@S4AK.com 06/28/2024 K"C�- 101zoI23 Zpw) MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE:(907)564-2762 BLOCK/LOT/TRACT: LT 21/ SUBDV: SKY RIDGE WASTEWATER LS231265 CONNECT PERMIT DATE OF APPLICATION: 10/17/2023 SCHEDULED COMPLETION DATE: 12/31/2023 TAX CODE: 01527521000 GRID: SW2634 STREET ADDRESS: 10851 SKY RIDGE DR Anchorage, AK 99516 OWNER: HULTQUIST HOMES INC MAIL ADDRESS: 12570 OLD SEWARD HIGHWAY ANCHORAGE, AK 995150000 CONTRACTOR: Hultquist Homes Inc ❑ Repair Existing Service Q On Property Only ❑ Hydrant Only ❑ Main Tap - To Property Line Only ❑ Main Tap & On Property Connect ❑ Disconnect R & R - Main Tap Only CONNECT SIZE 4 in REIMBURSABLE NUMBER REMARKS ❑ City Tap ❑ Cured in Place Pipe Row No. ❑ SINGLE FAMILY ❑ DUPLEX ❑ COMMERCIAL ❑ MULTI -DWELLING No. APTS 0 PHONE: ASSESSMENTS Main Line Extension Have Been Levied ❑ To Be Levied Comments: Owner Staff ISSUED WWVAH INSPECTION FEE $112.00 11�1 PAID ❑ CASH PERMIT FEE $77.00 CHECK RCC $1.30 OTHER DEPOSIT $0.00 INSPECTED BY i ! W(,] TOTAL $190.30 DATE I n 12 0lZ 3 PERMIT -FEE (Please Print) Hultquist Homes Inc MAIL ADDRESS 351 E 104th Anchorage, AK 99515 SIGNATURE EMAIL PHONE (907)522-3204 POST IN A CONSPICUOUS PLACE AT THE JOB SITE •�.�'�..�,.� INSPECTOR COPY DATE 12/31/2023 TIME 12:00 AM INSPECTOR SCHEDULED SUBDIVISION SKY RIDGE BLOCK/LOT/TRACT LT 21/ INDICATE NORTH z— R L sc�ol kk WL �' d tird SIZE MAIN: TYPE MAIN: DEPTH AT MAIN: i AT PROP. LINE: 0.6 CONNECT LOCATION: S` A) SW row COMMENTS: Coti4nakr Cw ( q s/ b Gorhtr 17 ' 1306 owul i'l4til ( led 7 L fin to oS kDU INSPECTED BY: V. 1 C k I DATE: 1620 2